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Tuesday, January 17

Vice President Biden on The Cancer Moonshot

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The 1461

World Economic Forum
Davos, Switzerland

Vice President Biden: Madam Ambassador, thanks for putting together a crowd for us. (Laughter.)

Folks, I’m delighted to be here and happy to be back with so many distinguished people. And I mean that sincerely. Many of you know as much or more about the subjects I’m going to speak to than I do, including -- is Elizabeth Blackburn here? Elizabeth, a Nobel Laureate, who found the BRCA gene. As that old saying goes, she’s forgotten more about this than I’m going to know.

But, folks, I’m happy to be back here at the World Economic Forum at Davos to talk about the fight against cancer. And I’m accompanied by Greg Simon, who is Executive Director of administration’s Cancer Moonshot and who will lead my Biden Cancer Initiative that I’ll launch after we leave office, which is in about 48 hours. (Laughter.) I hope I have a ride home. (Laughter.) I’ll talk about in a few moments.

But, Greg, where are you? Greg has had a great deal of experience in this area and he’s led the initiative the last year for the President and me.

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Last year, I arrived at the forum a few days after President Obama delivered his final State of the Union Address, where he announced, quite frankly to my surprise, that he was putting me in charge of a national Cancer Moonshot to double the rate of progress in preventing, diagnosing and treating cancer.

And I was not only genuinely surprised by the announcement, I was genuinely surprised by the response that I got both at home and abroad. Here at Davos I was scheduled -- Klaus had asked me to deliver the keynote address on the promise and perils of the

Fourth Industrial Revolution, and to participate in a few bilateral meetings over the remaining days.

But given the overwhelming interest in the Cancer Moonshot, the forum asked me if I could quickly convene a roundtable of cancer experts, among whom Elizabeth was one of them, to discuss where we are and where we need to go in the fight against cancer.

And so I did on a few days notice -- we put together such a roundtable -- and it kicked off what for me was a year-long journey that’s taken me literally around the world meeting with the best cancer researchers, doctors, nurses, and patients, as well as philanthropists, heads of state -- they've all been part of it.

But I’m back here today to outline how far we’ve come and what -- at least from our perspective -- what path we should chart moving forward.

And let me start with where we believe we are. When we announced the Cancer Moonshot, I knew there would be a lot of skeptics out there who’d say, “well, here we go again. Haven’t we done this before?”

President Nixon, when he declared War on Cancer in 1971, he was earnest and sincere and very committed. But what makes the difference between then and now is -- the single big difference is that he had no army. He had no resources. He had no weapons. He had no strategy to win.

But after 45 years with many of you in this room doing incredible work, 45 years of progress, after decades of funding research, training scientists and physicians, treating millions of patients, we now have an army. We now have powerful new technologies and tools, like: Immunotherapy that -- by the way, even six, eight, 10 years ago was viewed kind of as a voodoo science out there. It wasn’t really an integral part of this fight -- that makes cancer cells visible to the immune system so our natural defenses can destroy the cancer.

Surgeons are using cutting-edge robotics to allow for more precise imaging to find the cancer and more precisely surgically remove the cancer in hard-to-reach areas.

Liquid biopsies that find early signs of cancer in the blood and tell you whether or not you have a particular cancer.

These advances and many others provide hope that more precise medicines and diagnostics might greatly improve and detect and defeat cancer.

But on so many levels, we’ve now reached an inflection point. When the system was set up before, we thought there was basically only one cancer in different parts of the body. We’ve now learned there are over 200 specific kinds of cancers.

After decades we thought we could tackle cancer one discipline at a time. But that's not how cancer operates. Cancer uses every tool at its disposal -- it hides from the immune system, it builds it own blood supply system, it uses viruses to spread, it engineers a friendlier environment, a cellular environment in which to survive.

And it knows how to spread through the body using pathways and mutations we don’t understand fully yet. And cancer never gives up, it never surrenders. That's why we have to use every discipline cancer does, and that's what we’re starting to in a way that's only really begun in the last five or six, seven years.

Five years ago as I said, oncologists weren’t routinely working closely with immunologists, virologists, geneticists, chemical and biological engineers. And now they are.

Immunotherapies are finding the keys to making cancer cells visible and targeting them. Virologist are now working on vaccines to prevent and treat cancers. Geneticists are cataloging mutations that drive cancers. And chemical and biological engineers are helping engineer environments hostile to cancer. And they’re all working together.

Like many of you, I decided to become acquainted with this after someone close to me in my family was diagnosed. You tend to try to learn everything you possibly can once that occurs. And I knew little about the discipline. And like I said, what impressed me was that so much of this is really very brand new in terms of the collaboration.

Also, there’s a recognition that by aggregating and sharing millions of patients’ data, like genomics, family history, lifestyles, treatment outcomes and by using supercomputing power that we can do now a million billion calculations a second, we can understand why one therapy or treatment works for one person and not for another for the same exact cancer.

And today, it was just announced that two major data sharing organizations, who were part of the roundtable. Five of them were here when we had the roundtable last year, two of them -- Cancer LinQ and another that focuses on genomic information called Project Genie -- are joining forces to accelerate data sharing of real-world clinical data that will improve cancers.

After the meeting we had here, I asked the five groups that we're focusing on data sharing -- on aggregating data, I asked them whether they’d meet with me in Washington privately. And they came to my office, and we sat for an hour and a half. And I asked each of them to explain to me -- help educate me as to what they were doing. And I remember when we finished saying something that will not surprise you all, but you said, didn't you know that, Joe? I looked and said, but it sounds like you're all doing the same thing. No, I’m not being facetious. I said, you've all just made the case to me the more data you can aggregate across a spectrum, the more likely you are to find patterns, the most likely you are to find cures and/or treatments. Why aren’t you talking to one another?

And I remember afterwards several of them walking up to me as we were having coffee and pulling me aside and say, keep this up. Keep this up. But I didn't -- I had nothing to do with this sharing and collaboration. But the point is the mood is changing as I feel it just in the last year.

I also learned from the best minds in the world that the strategy we’ve been following is equivalent to fighting the last war. The model of scientific breakthroughs for most of the history was one of individual achievement, Jonas Salk in the laboratory finding the -- creating the polio vaccine. There was little -- if any -- sharing among hospitals and researchers, and little ability to share even if they wanted to share.

And across the world, our funding processes and systems of academic research primarily follow that old model. So the Moonshot has fundamentally been about two things since I began it. And the first objective I’ve had was to inject the urgency of now into this fight and double the rate of progress and do in five years instead of 10.

And when I say urgency of now, the brightest minds I’ve met in the world -- and I’ve been doing my job and mostly working on strategic doctrine and foreign policy my career -- the brightest people I’ve met, I’ve met now and spoken with over 13,000 cancer researchers in the two major organizations. I’ve met with scores and scores of leaders in the field. I’ve met with seven or eight Nobel Laureates in the field. And the amazing thing to me is that they're all working so hard. But with a few changes, even without learning more information, we could probably extend the life of a lot of people.

The one thing that the clinicians can tell you is -- and those of you who are clinicians -- how many times have you had a patient say to you, Doctor, can you just -- I know you can't save me, but can you just give me two more weeks so I can watch her get married, doc? Doc, can you just keep me around for another month so I can see my first grandchild born, doc? Doc, I’m not asking for anything except can you just extend a little bit? I might be able to get my finances in order.

You hear that all the time. I heard that at my son’s beside. He wasn’t afraid of dying, but he wanted to settle a few things. Greater collaboration with no new breakthroughs can have the possibility of being able to say to one in four or five of those patients, yes, I can figure a way, just a little longer.

The second thing, objective I had was changing the culture, coming up with a new strategy for this fight. Not for the strategy for the last fight.

We have four primary structures for organizing the Moonshot. One, we established the White House Cancer Moonshot Task Force to reimagine the federal government’s fight and role in this fight to break down silos in the federal government. I went all over the world literally asking for suggestions: What should we be doing better?

Under this task force, which I engaged and Greg met with members of each of the departments at least once every two weeks for updates on progress that was being made on things we were trying to do, we engaged everyone from the National Institutes of Health, to the Defense Department and to Veterans Affairs -- but to some agencies never been involved. NASA -- everybody would go why in the hell are they bringing NASA into this, or the Patent Office, or the Environmental Protection Agency, or the White House policy councils, the Office of Science and Technology Policy, the Office of Management and Budget, they all have a role to play.

Secondly, we hosted a Cancer Moonshot Summit in June. Some of you participated in that summit. We held it in D.C., over 400 of you came. We had roundtables on various aspects of dealing with cancer. Some of you were there, made significant contributions. But interestingly enough, we simulcast, in effect, these roundtables where 7,000 people around the country gathered in 300 local summits held in every single state, including Guam and Puerto Rico to try to again inject this notion of the urgency of now.

And the summit workshops launched a torrent of new collaborations and innovative initiatives across all sectors, and they continue to this day.

For example, we got a call from IBM. How would you like to borrow Watson? They came to us and offered Watson, their supercomputer, to partner with the largest hospital in the world, the Department of Defense and the Veterans Affairs. So now a veteran can get her genome or tumor sequenced at Walter Reed, and they're very good at it and they can do it quickly, and then Watson will search all specific therapies that would target that particular cancer and provide recommendations to the physicians and tumor boards to use in choosing the right therapy. So you increase the prospect that the first time out will be the best shot out.

In June, I was at the University of Chicago, where we launched the National Cancer Institute Genomic Data Commons. The purpose was to bring together cancer sequencing data and related patient information from the Cancer Genome Atlas. Well, that atlas comprised roughly 14,000 individuals with that data. Now the database has grown now to over 30,000 individuals. And our international agreements are going to add tens of thousands of more patients’ data.

And Amazon came along and says, look, we’ll agree to make their cloud computing available to help us store these enormous amounts of data that this project is going to generate.

But the important thing is, that it’s a totally open-access database, able to be accessed by any researcher in the world, eliminating the silos. It did not exist a year ago. And this data has already been accessed and used more than 5 million times, and this was in the spring of last year -- increasing chances exponentially that we may find some answers.

We’ve also transformed access to cancer clinical trials. In the United States only 4 percent of the people diagnosed with cancer ever become part of a clinical trial, which is how research advances and may be the only possibility of saving the patient’s life. Maybe.

So we engaged the President’s Innovation Fellows, some of the top, young technology minds in the world, mostly from Silicon Valley, who have dedicated a year to come in. These are trying to modernize the whole government. So I went to them and said, look, there’s no way anyone can rationally go and figure out that that oncologist from Bemidji, Minnesota, who has come up with an accurate diagnosis doesn't know where to turn. He’s not near one of the great cancer centers in the United States. So where do they go?

There was a site that said you could click on and find out where there were cancer trials. But it was useless. So these brilliant, young -- they range in age from 25 to 40 thereabouts -- within three weeks put together a site. They can go now. It’s trials.cancer.gov. Type in real words like breast cancer, leukemia, and ZIP codes, age, and then find a list of clinical trials near you or your loved one that previously you could not have easily found. And find the people equally excited about this are the pharmaceutical companies. They have trouble finding enough people for their trials.

You and your doctor can now find out what trials are available for your types of cancer near you.

Another example is NASA I mentioned earlier, working with the National Cancer Institute, establishing a new collaboration to study the biological effects of particle beam radiotherapy, a novel technology that may deliver a more targeted dose of radiation to tumor cells.

The Centers for Disease Control and Prevention is advancing the effort to promote cancer vaccines like the HPV vaccine that are safe and effective strategies for combatting viruses -- for various types of cancer.

The Moonshot also initiated the Blood Profiling Atlas Pilot. Representatives from the government, academia, and pharmaceutical and diagnostic companies are launching partnerships to create an open database for liquid biopsies to accelerate the development of safe and effective blood profiling diagnostic technologies and our patient will benefit from this.

Stanford Medicine and the VA in Palo Alto are collaborating to establish the Hadron Center in Palo Alto, California, for the potential benefit of both Veteran and non-Veteran cancer patients.

The Hadron Center will utilize particle-beam radiotherapy using beams of charged particles such as proton and helium, carbon, or other ions to allow more precise targeting everywhere inside the patient's body, potentially -- we don't know yet -- resulting in less damage to healthy cells.

The reason NASA got in the game is they know more about radiation than anybody in the world, so they're participating.

Earlier this year we announced what we call the NCI -- the National Cancer Institute Formulary. This is a public-private partnership with more than two dozen pharmaceutical and biotechnology companies which allows researchers to test existing drugs for new combinations that could be effective against different types of cancer.

This is how it works. When you go into a bar and you listen to a song and you put money in a jukebox, you don’t have to negotiate a licensing agreement with each song from the record company you're about to play. That licensing agreement has already been worked out.

But until recently, if you waited to use -- you've wanted to use a combination of drug, you had to go through each company, get permission to use each different drug. It literally could take years. And a lot of people got lost in the meantime that might have been saved.

Now, the NCI has already worked out the details of intellectual property, access, and licensing so researchers and companies know there is an agreement on licensing if the drug is successful and how the intellectual property will be shared.

This new system just launched. And I urge as many of you as possible to join it, participate, and share. It will make an enormous difference potentially.

Combination drugs have the potential to do for cancers what many of you have done for HIV. There was total collaboration in HIV.

There are dozens of other actions that you can read about in WhiteHouse.gov/CancerMoonshot.

The third thing we did was we created a Cancer Moonshot blue ribbon panel at our national institute to recommend research that holds the most promise for additional investments. Some of you were named to that panel. My dad used to have an expression. He said, Joey, if everything is equally important to you, nothing is important to you. What do the best minds in the world think are the best therapies or technologies we should be pursuing as rapidly as we can, in what order?

That blue ribbon panel delivered a report with transformative recommendations to change the research blueprint for the National Cancer Institute.

For example: Launching a 3-D Cancer Atlas. Oncologists today rely on past experience, consultation with multidisciplinary teams, published studies, and other sources to make diagnosis and treatment decisions.

But providing a web-based catalog of the genetic lesions and cellular interactions in a tumor, immune and other cells in the tumor, the microenvironment -- one that maps the evolution of tumor -- from development to metastasis, it’s going to enable researchers to develop predictive models for tumor progression and response to treatment that will ultimately help oncologists make informed treatment decisions for each patient

Now none of this is a guaranteed promise. But it all holds significant potential. Establishing a national network of cancer patients that, with appropriate privacy safeguards, will provide them with a genetic profile of their own cancer and let them “pre-register” for clinical trials, so they can be contacted when a trial in which they may be eligible opens; establishing clinical trials networks devoted exclusively to immunotherapies for pediatric and adult cancers would advance research in this area and could lead to new vaccines to prevent cancers of all types in children, as well as adults; expanding the use of proven cancer prevention and early detection strategies.

Boosting prevention research to identify ways to increase the uptake of these strategies, especially in medically underserved populations could greatly reduce the incidence and death from lung and other tobacco-related cancers, colorectal cancer, cervical and other HPV-related cancers, respectively.

Here’s why it matters. By some estimates, at least 50 percent of the cancers can be prevented, and that prevention falls into three major categories:

One: Personal actions on the part of the individual, such as living a healthier lifestyle, avoiding cancer risk behaviors, like smoking.

The second way of prevention is the responsibilities of government and industry to reduce carcinogens and toxins in the air we breathe, the water we drink, the soil we grow our food in.

And the third is to make available existing diagnostic tools to all communities -- because we know the earlier cancer is detected, the better prospect for an outcome that's good.

But there is a fourth outcome, an entirely new set of diagnostic tools that can detect cancers earlier, new technologies like hereditary markers. Instead of waiting until you're 48 years old to get your first colonoscopy, if they have the marker, get it when you're 16 years old.

And by continuing to keep an eye on it, prevent you from being the victim of dying of cancer -- of that cancer.

The fourth -- and in addition to the task force report, I was asked to deliver a report to the President in October that included the progress made ‘16 and my assessment -- and it’s only mine of what the road ahead looks like. Obviously, I would like you all to look at that and critique it.

The report lays out the changes we need in our view to implement -- to implement at our research institutions and universities to align our research system with the realities and opportunities of the 21st century.

And all this has helped us make progress on the international fight against cancer.

Last April I delivered remarks at conference on Regenerative Medicine hosted by the Vatican and that the Pope addressed as well. I laid out what I thought to be the guideposts for international collaboration through the Moonshot.

One: Focus on prevention, access, and affordability around the world.

Two: Raise the urgency of international response to cancer, reflecting the same urgency we bring to infectious disease threats. There are 16 Million people who will die from cancer this year. And according to many of the experts in the audience, if we don’t do anything about it, there will be 26 million dying by 2020.

Increase research and patient data sharing among researchers, institutions, foundations, nations. Support standardization of data and biorepositories. Increase government investment and cancer research -- we should increase it to capitalize on this moment, of this inflection point.

Since then, the United States has signed 10 memoranda of understanding in nine countries. I’m supposedly an expert on foreign policy. An expert is anyone from out of town with a briefcase. (Laughter.) I have traveled over 1.3 million miles for the President, meeting with heads of state, most of whom I’ve known most of my career. I was recently in the Gulf, the Persian Gulf recently, seven months ago, talking about the fight against ISIS with a head of state, sitting on the Gulf, the Persian Gulf, talking about -- he had his people lined up on one side of a table outside and I had mine for a dinner. And before we began, he said, Mr. Vice President, before we talk about ISIS -- they call it Daesh -- before we talk about Daesh, can we talk about cancer? We want to help.

In that tour through the Middle East in Jordan and Israel, can we talk about cancer?

The President put together and 50 heads of state came in the East Room with rectangular tables lined up around the entire room with 50 heads of state on how to deal with the nuclear proliferation. The President sat in front of the fireplace. And I was directly across from him, my back to that famous hallway. Before he began he said, I know a lot of you want to talk to Joe about cancer, but let’s deal with the nuclear issue first. (Laughter.) He wasn’t being facetious. The result -- whether I was in Melbourne, Japan, the UAE, we've signed -- we were sought after and signed 10 detailed memorandum of understanding as to how we should jointly proceed.

These have focused on data sharing and advanced research.

Last month, we saw the United States Congress come together. I know I’m supposedly the guy that Republicans and Democrats like in the Congress. I actually respect the Congress. That's part of the problem that people think I have. But I genuinely do. And we could get anything through the Congress.

But through the leadership of some Republicans in the House and Democrats in the Senate, they put together what they call the 21st Century Cures Act, and no one thought we could pass it. At the very waning hours, we were able to go up and get them jointly to appropriate and commit to 6.3 billion in biomedical and health-related research, including $1.8 billion for the National Cancer Institute to invest in additional research as part of the Moonshot. This is the one bipartisan thing that exists, and I pray will continue to exist in the new administration.

But it also is an international consensus. So we have enormous opportunities I believe with greater collaboration, but organizing a different pathway than we've been following.

This investment, in my view, should be matched by other nations who agree that now is the time to double-down in our fight against cancer. And it’s my hope, as I’ve already spoken to the Vice President-elect, who is a good man, about to come in to be Vice President in four days or three days, about my willingness to continue to work with him and the incoming administration to be committed and enthusiastic as we are to the goal of ending cancer as we know it. And my prayer is they will do that, as well.

But I know those in the private sector, philanthropy, at academic institutions and non-profit organizations, will continue the work regardless of what the next administration does. There’s too much momentum here. And this will include me as a private citizen.

I do not have -- I hope I’m well informed, but I don't have the expertise most of you have, but I’ve found I have the power to convene and thus far I’ve been viewed as a fair dealer. I have no interest in any one institution or another. And I maybe even have the ability to occasionally shame so people move in directions that up to now there’s been unwillingness to move because of the culture that's developed.

After I leave office, after meeting with some very significant people who many of you know -- a coupe in this room as well -- who have encouraged me to set up the Biden Cancer Initiative with similar goals of the Moonshot, changing the way we do business in cancer research and development and providing cancer care.

The initiative will focus on, one, improving data standards and giving patients a mechanism to share their data, so they can help many other patients going through the same fight; and so researchers can use the data to find new patients and new cures. Most people are not experts like you. They think that already exists, that patients actually own their own data; that people -- they actually have access to their own data. I was with one particular researcher, and he said, well, we're having trouble getting patients. And I said, I tell you what, I’ll make you a bet -- the press was with me, like here -- I said, I bet if I ask them, their networks will give me 15 minutes of primetime to talk about this. I said, if I pick one single repository, I’ll bet you I get minimum between 2 million and 10 million patients who the next morning will give you their data, say they’ll send it there. And this researcher said, well, yes, maybe you have a point.

Guys, this is not -- this is within our wheelhouse. That's the easy part. The hard part is what you all do.

Working with community care organizations to help improve access to care and quality of care is another focus that we'll have. So outcomes aren’t wholly dictated by your ZIP code.

And convening a national conversation with pharmaceutical companies, insurers, biotech companies, and others to ensure patients can afford treatments. Too many Americans are forced to sell their homes, go into bankruptcy, just so a loved one can get the care and hope for the cure. That needs to change.

And these companies need to have serious remuneration. They're taking real risks. But there’s got to be a way we can figure this out.

And also calling for greater transparency and access to clinical trials, so more patients can get access to treatments that might work for their cancer.

And continuing to work for cultural change and improvements in our cancer research system, so we can make the best use of today’s opportunities to generate, share and knowledge from patients and researchers to help patients everywhere around the world.

These are the reasons why I plan on staying involved -- because for the first time in 45 years, there is some real movement toward collaboration. Not because people are selfish, but because it wasn’t the model. It’s not the way it worked for good reason. But the collaboration between cancer centers, drug companies, the insurance industry, and government is where the solution lies -- and how we’ll end cancer as we know it.

So let me conclude by saying, which will not shock you: I am optimistic. (Laughter.) I know I’m always optimistic. But I am optimistic because of the absolute commitment and sheer brilliance I have been exposed to from so many researchers and scientists and these great institutions.

I see the day when patients get the right therapy the first time for their cancer, where prevention is more effective, and
where care is personalized and more effective with less harmful side effects.

I see the day when those younger people of you in this room, when you take your children and grandchildren later for their school physical, that they will -- at the time they get their vaccination against measles and mumps, they’ll be vaccinated against certain types of cancer -- like you can be vaccinated against HPV virus.

I see the day when we’ll be able to identify through markers in the blood, cancers that haven’t even developed yet.

And the one thing I can tell you: There is hope.

I’m willing to bet everyone in this room who has had cancer, or has a loved one who has had cancer, you understand that feeling when the doctor says, it’s cancer.

You all know, at that moment, the one thing you most need is some reason to hope.

When President Kennedy discussed sending humankind to the moon, he talked about the commitment the nation -- and this is the phrase he used -- the commitment the nation was “unwilling to postpone.”

A very famous speech, and some of you can probably recite the speech, but the part of the speech since I’ve been a kid that got me the most about my notion about governance, my notion about exploration, my notion about science was when a nation or a people “unwilling to postpone.” We should be unwilling to postpone finding the answer to how to end cancer as we know it.

And I’m confident we can do it. You're already doing it. But let’s double down. It is about the urgency of now.

I thank you all for your graciousness in listening and thank you for having me.